[Congressional Record Volume 150, Number 93 (Thursday, July 8, 2004)]
[Senate]
[Pages S7864-S7867]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
GARRETT LEE SMITH MEMORIAL ACT
Mr. FRIST. Mr. President, I ask unanimous consent that the Senate
proceed to the immediate consideration of S. 2634, introduced earlier
today by Senators Dodd, DeWine, Reed, Smith, Reid, Daschle, and others.
The PRESIDING OFFICER. The clerk will state the bill by title.
The legislative clerk read as follows:
A bill (S. 2634) to amend the Public Health Service Act to
support planning, implementation, and evaluation of organized
activities involving statewide youth suicide early
intervention and prevention strategies, to provide funds for
campus mental and behavioral health service centers.
There being no objection, the Senate proceeded to consider the bill.
Mr. FRIST. Mr. President, I ask unanimous consent that the bill be
read the third time and passed, the motion to reconsider be laid upon
the table, and that any statements relating to the bill be printed in
the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The bill (S. 2634) was read the third time and passed, as follows:
S. 2634
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Garrett Lee Smith Memorial
Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) More children and young adults die from suicide each
year than from cancer, heart disease, AIDS, birth defects,
stroke, and chronic lung disease combined.
(2) Over 4,000 children and young adults tragically take
their lives every year, making suicide the third overall
cause of death between the ages of 10 and 24. According to
the Centers for Disease Control and Prevention suicide is the
third overall cause of death among college-age students.
(3) According to the National Center for Injury Prevention
and Control of the Centers for Disease Control and
Prevention, children and young adults accounted for 15
percent of all suicides completed in 2000.
(4) From 1952 to 1995, the rate of suicide in children and
young adults has tripled.
(5) From 1980 to 1997, the rate of suicide among young
adults ages 15 to 19 increased 11 percent.
(6) From 1980 to 1997, the rate of suicide among children
ages 10 to 14 increased 109 percent.
(7) According to the National Center of Health Statistics,
suicide rates among Native Americans range from 1.5 to 3
times the national average for other groups, with young
people ages 15 to 34 making up 64 percent of all suicides.
(8) Congress has recognized that youth suicide is a public
health tragedy linked to underlying mental health problems
and that youth suicide early intervention and prevention
activities are national priorities.
(9) Youth suicide early intervention and prevention have
been listed as urgent public health priorities by the
President's New Freedom Commission in Mental Health (2002),
the Institute of Medicine's Reducing Suicide: A National
Imperative (2002), the National Strategy for Suicide
Prevention: Goals and Objectives for Action (2001), and the
Surgeon General's Call to Action To Prevent Suicide (1999).
(10) Many States have already developed comprehensive
Statewide youth suicide early intervention and prevention
strategies that seek to provide effective early intervention
and prevention services.
(11) In a recent report, a startling 85 percent of college
counseling centers revealed an increase in the number of
students they see with psychological problems. Furthermore,
the American College Health Association found that 61 percent
of college students reported feeling hopeless, 45 percent
said they felt so depressed they could barely function, and 9
percent felt suicidal.
(12) There is clear evidence of an increased incidence of
depression among college students. According to a survey
described in the Chronicle of Higher Education (February 1,
2002), depression among freshmen has nearly doubled (from 8.2
percent to 16.3 percent). Without treatment, researchers
recently noted that ``depressed adolescents are at risk for
school failure, social isolation, promiscuity, self
medication with drugs and alcohol, and suicide--now the third
leading cause of death among 10-24 year olds.''.
(13) Researchers who conducted the study ``Changes in
Counseling Center Client Problems Across 13 Years'' (1989-
2001) at Kansas State University stated that ``students are
experiencing more stress, more anxiety, more depression than
they were a decade ago.'' (The Chronicle of Higher Education,
February 14, 2003).
(14) According to the 2001 National Household Survey on
Drug Abuse, 20 percent of full-time undergraduate college
students use illicit drugs.
(15) The 2001 National Household Survey on Drug Abuse also
reported that 18.4 percent of adults aged 18 to 24 are
dependent on or abusing illicit drugs or alcohol. In
addition, the study found that ``serious mental illness is
highly correlated with substance dependence or abuse. Among
adults with serious mental illness in 2001, 20.3 percent were
dependent on or abused alcohol or illicit drugs, while the
rate among adults without serious mental illness was only 6.3
percent.''.
(16) A 2003 Gallagher's Survey of Counseling Center
Directors found that 81 percent were concerned about the
increasing number of students with more serious psychological
problems, 67 percent reported a need for more psychiatric
services, and 63 percent reported problems with growing
demand for services without an appropriate increase in
resources.
(17) The International Association of Counseling Services
accreditation standards recommend 1 counselor per 1,000 to
1,500 students. According to the 2003 Gallagher's Survey of
Counseling Center Directors, the ratio of counselors to
students is as high as 1 counselor per 2,400 students at
institutions of higher education with more than 15,000
students.
[[Page S7865]]
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICES ACT.
Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq) is amended--
(1) in section 520E (42 U.S.C. 290bb-36)--
(A) in the section heading by striking ``CHILDREN AND
ADOLESCENTS'' and inserting ``YOUTH'';
(B) by striking subsection (a) and inserting the following:
``(a) In General.--The Secretary shall award grants or
cooperative agreements to public organizations, private
nonprofit organizations, political subdivisions, and
Federally recognized Indian tribes or tribal organizations to
implement the State-sponsored statewide or tribal youth
suicide early intervention and prevention strategy as
developed under section 596A.'';
(C) in subsection (b), by striking all after
``coordinated'' and inserting ``with the Strategy for Suicide
Prevention Federal Steering Group and the suicide prevention
resource center provided for under section 596B.'';
(D) in subsection (c)--
(i) in the matter preceding paragraph (1), by striking ``A
State'' and all that follows through ``desiring'' and
inserting ``A public organization, private nonprofit
organization, political subdivision, and Federally recognized
Indian tribes or tribal organization desiring'';
(ii) by redesignating paragraphs (1) through (9) as
paragraphs (2) through (10), respectively;
(iii) by inserting before paragraph (2) (as so
redesignated), the following:
``(1) comply with the State-sponsored statewide early
intervention and prevention strategy as developed under
section 596A;'';
(iv) in paragraph (2) (as so redesignated), by striking
``children and adolescents'' and inserting ``youth'';
(v) in paragraph (3) (as so redesignated), by striking
``best evidence-based,'';
(vi) in paragraph (4) (as so redesignated), by striking
``primary'' and all that follows and inserting ``general,
mental, and behavioral health services, and substance abuse
services;'';
(vii) in paragraph (5) (as so redesignated), by striking
``children and'' and all that follows and inserting ``youth
including the school systems, educational institutions,
juvenile justice system, substance abuse programs, mental
health programs, foster care systems, and community child and
youth support organizations;'';
(viii) by striking paragraph (8) (as so redesignated), and
inserting the following:
``(8) offer access to services and care to youth with
diverse linguistic and cultural backgrounds;''; and
(ix) by striking paragraph (9) (as so redesignated), and
inserting the following:
``(9) conduct annual self-evaluations of outcomes and
activities, including consulting with interested families and
advocacy organizations;'';
(E) by striking subsection (d) and inserting the following:
``(d) Use of Funds.--Amounts provided under a grant or
cooperative agreement under this section shall be used to
supplement, and not supplant, Federal and non-Federal funds
available for carrying out the activities described in this
section. Applicants shall provide financial information to
demonstrate compliance with this section.'';
(F) in subsection (e)--
(i) by striking ``contract,''; and
(ii) by inserting after ``Secretary that the'' the
following: ``application complies with the State-sponsored
statewide early intervention and prevention strategy as
developed under section 596A and'';
(G) in subsection (f), by striking ``contracts,'';
(H) in subsection (g)--
(i) by striking ``A State'' and all that follows through
``organization receiving'' and inserting ``A public
organization, private nonprofit organization, political
subdivision, and Federally recognized Indian tribes or tribal
organization receiving''; and
(ii) by striking ``contract,'' each place that such
appears;
(I) in subsection (h), by striking ``contracts,'';
(J) in subsection (i)--
(i) by striking ``A State'' and all that follows through
``organization receiving'' and inserting ``A public
organization, private nonprofit organization, political
subdivision, and Federally recognized Indian tribes or tribal
organization receiving''; and
(ii) by striking ``contract,'';
(K) in subsection (k), by striking ``5 years'' and
inserting ``3 years'';
(L) in subsection (l)(2), by striking ``21'' and inserting
``24''; and
(M) in subsection (m)--
(i) by striking ``Appropriation.--'' and all that follows
through ``For'' in paragraph (1) and inserting
``Appropriation.--For''; and
(ii) by striking paragraph (2);
(2) by inserting after part I (42 U.S.C. 290jj et seq), the
following:
``PART J--SUICIDE EARLY INTERVENTION AND PREVENTION'';
(3) by redesignating section 520E (42 U.S.C. 290bb-36), as
amended by paragraph (1), as section 596 and transferring
such section to part J (as added by paragraph (2)); and
(4) by adding at the end of part J (as added by paragraph
(2) and amended by paragraph (3)), the following:
``SEC. 596A. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION
STRATEGIES, TRAINING, AND TECHNICAL ASSISTANCE.
``(a) Youth Suicide Early Intervention and Prevention
Strategies.--
``(1) In general.--The Secretary acting through the
Administrator of the Substance Abuse and Mental Health
Services Administration, shall award grants or cooperative
agreements to eligible entities to--
``(A) develop and implement State-sponsored statewide or
tribal youth suicide early intervention and prevention
strategies in schools, educational institutions, juvenile
justice systems, substance abuse programs, mental health
programs, foster care systems, and other child and youth
support organizations;
``(B) support public organizations and private nonprofit
organizations actively involved in State-sponsored statewide
or tribal youth suicide early intervention and prevention
strategies and in the development and continuation of State-
sponsored statewide youth suicide early intervention and
prevention strategies;
``(C) collect and analyze data on State-sponsored statewide
or tribal youth suicide early intervention and prevention
services that can be used to monitor the effectiveness of
such services and for research, technical assistance, and
policy development; and
``(D) assist eligible entities, through State-sponsored
statewide or tribal youth suicide early intervention and
prevention strategies, in achieving targets for youth suicide
reductions under title V of the Social Security Act (42
U.S.C. 701 et seq.).
``(2) Eligible entity.--
``(A) Definition.--In this subsection, the term `eligible
entity' means--
``(i) a State;
``(ii) a public organization or private nonprofit
organization designated by a State to develop or direct the
State-sponsored statewide youth suicide early intervention
and prevention strategy; and
``(iii) a Federally-recognized Indian tribe or tribal
organization (as defined in the Indian Self-Determination and
Education Assistance Act) or an urban Indian organization (as
defined in the Indian Health Care Improvement Act) that is
actively involved in the development and continuation of a
tribal youth suicide early intervention and prevention
strategy.
``(B) Preference.--In awarding grants and cooperative
agreements under this section, the Secretary shall give
preference to States that have rates of youth suicide that
significantly exceed the national average as determined by
the Centers for Disease Control and Prevention.
``(C) Limitation.--In carrying out this section, the
Secretary shall ensure that each State is awarded only one
grant or cooperative agreement under this section. For
purposes of the preceding sentence, a State shall be
considered to have been awarded a grant or cooperative
agreement if the eligible entity involved is the State or an
entity designated by the State under subparagraph (A)(ii).
Nothing in this subparagraph shall be construed to apply to
entities described in subparagraph (A)(iii).
``(3) Preference.--In providing assistance under a grant or
cooperative agreement under this subsection, an eligible
entity shall give preference to public organizations, private
nonprofit organizations, political subdivisions, and tribal
organizations actively involved with the State-sponsored
statewide or tribal youth suicide early intervention and
prevention strategy that--
``(A) provide early intervention and assessment services,
including screening programs, to youth who are at risk for
mental or emotional disorders that may lead to a suicide
attempt, and that are integrated with, school systems,
educational institutions, juvenile justice systems, substance
abuse programs, mental health programs, foster care systems,
and other child and youth support organizations;
``(B) demonstrate collaboration among early intervention
and prevention services or certify that entities will engage
in future collaboration;
``(C) employ or include in their applications a commitment
to evaluate youth suicide early intervention and prevention
practices and strategies adapted to the local community;
``(D) provide timely referrals for appropriate community-
based mental health care and treatment of youth who are at
risk for suicide in child-serving settings and agencies;
``(E) provide immediate support and information resources
to families of youth who are at risk for suicide;
``(F) offer access to services and care to youth with
diverse linguistic and cultural backgrounds;
``(G) offer appropriate post-suicide intervention services,
care, and information to families, friends, schools,
educational institutions, juvenile justice systems, substance
abuse programs, mental health programs, foster care systems,
and other child and youth support organizations of youth who
recently completed suicide;
``(H) offer continuous and up-to-date information and
awareness campaigns that target parents, family members,
child care professionals, community care providers, and the
general public and highlight the risk factors associated with
youth suicide and the life-saving help and care available
from early intervention and prevention services;
``(I) ensure that information and awareness campaigns on
youth suicide risk factors, and early intervention and
prevention services, use effective communication mechanisms
[[Page S7866]]
that are targeted to and reach youth, families, schools,
educational institutions, and youth organizations;
``(J) provide a timely response system to ensure that
child-serving professionals and providers are properly
trained in youth suicide early intervention and prevention
strategies and that child-serving professionals and providers
involved in early intervention and prevention services are
properly trained in effectively identifying youth who are at
risk for suicide;
``(K) provide continuous training activities for child care
professionals and community care providers on the latest
youth suicide early intervention and prevention services
practices and strategies;
``(L) conduct annual self-evaluations of outcomes and
activities, including consulting with interested families and
advocacy organizations; and
``(M) provide services in areas or regions with rates of
youth suicide that exceed the national average as determined
by the Centers for Disease Control and Prevention.
``(4) Requirement for direct services.--Not less than 85
percent of grant funds received under this subsection shall
be used to provide direct services.
``(b) Suicide Prevention Resource Center; Training and
Technical Assistance.--
``(1) Operation of center.--The Secretary, acting through
the Administrator of the Substance Abuse and Mental Health
Services Administration and in consultation with the National
Strategy for Suicide Prevention Federal Steering Group, shall
award a competitive grant or contract to a public or private
nonprofit entity for the establishment of a Suicide
Prevention Resource Center to carry out the activities
described in paragraph (3).
``(2) Application.--To be eligible for a grant or contract
under paragraph (1), an entity shall prepare and submit to
the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
``(3) Authorized activities.--The Suicide Prevention
Resource Center shall provide appropriate information,
training, and technical assistance to States, political
subdivisions of a State, Federally recognized Indian tribes,
tribal organizations, public organizations, or private
nonprofit organizations for--
``(A) the development or continuation of statewide or
tribal youth suicide early intervention and prevention
strategies;
``(B) ensuring the surveillance of youth suicide early
intervention and prevention strategies;
``(C) studying the costs and effectiveness of statewide
youth suicide early intervention and prevention strategies in
order to provide information concerning relevant issues of
importance to State, tribal, and national policymakers;
``(D) further identifying and understanding causes and
associated risk factors for youth suicide;
``(E) analyzing the efficacy of new and existing youth
suicide early intervention techniques and technology;
``(F) ensuring the surveillance of suicidal behaviors and
nonfatal suicidal attempts;
``(G) studying the effectiveness of State-sponsored
statewide and tribal youth suicide early intervention and
prevention strategies on the overall wellness and health
promotion strategies related to suicide attempts;
``(H) promoting the sharing of data regarding youth suicide
with Federal agencies involved with youth suicide early
intervention and prevention, and State-sponsored statewide or
tribal youth suicide early intervention and prevention
strategies for the purpose of identifying previously unknown
mental health causes and associated risk-factors for suicide
in youth; and
``(I) other activities determined appropriate by the
Secretary.
``(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $3,000,000
for fiscal year 2005, $4,000,000 for fiscal year 2006, and
$5,000,000 for fiscal year 2007.
``(c) Coordination and Collaboration.--
``(1) In general.--In carrying out this section, the
Secretary shall collaborate with the National Strategy for
Suicide Prevention Federal Steering Group and other Federal
agencies responsible for early intervention and prevention
services relating to youth suicide.
``(2) Consultation.--In carrying out this section, the
Secretary shall consult with--
``(A) State and local agencies, including agencies
responsible for early intervention and prevention services
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.), the State Children's Health Insurance Program under
title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.), programs funded by grants under title V of the Social
Security Act (42 U.S.C. 701 et seq.), and programs under part
C of the Individuals with Disabilities Education Act (20
U.S.C. 1431 et seq.);
``(B) local and national organizations that serve youth at
risk for suicide and their families;
``(C) relevant national medical and other health and
education specialty organizations;
``(D) youth who are at risk for suicide, who have survived
suicide attempts, or who are currently receiving care from
early intervention services;
``(E) families and friends of youth who are at risk for
suicide, who have survived suicide attempts, who are
currently receiving care from early intervention and
prevention services, or who have completed suicide;
``(F) qualified professionals who possess the specialized
knowledge, skills, experience, and relevant attributes needed
to serve youth at risk for suicide and their families; and
``(G) third-party payers, managed care organizations, and
related commercial industries.
``(3) Policy development.--The Secretary shall--
``(A) coordinate and collaborate on policy development at
the Federal level with the National Strategy for Suicide
Prevention Federal Steering Group; and
``(B) consult on policy development at the Federal level
with the private sector, including consumer, medical, suicide
prevention advocacy groups, and other health and education
professional-based organizations, with respect to State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies.
``(d) Rule of Construction; Religious Accommodation.--
Nothing in this section shall be construed to preempt any
State law, including any State law that does not require the
suicide early intervention for youth whose parents or legal
guardians object to such early intervention based on the
parents' or legal guardians' religious beliefs.
``(e) Evaluations and report.--
``(1) Evaluations by eligible entities.--Not later than 18
months after receiving a grant or cooperative agreement under
subsection (a), an eligible entity shall submit to the
Secretary the results of an evaluation to be conducted by the
entity concerning the effectiveness of the activities carried
out under the grant or agreement.
``(2) Report.--Not later than 2 years after the date of
enactment of this section, the Secretary shall submit to the
appropriate committees of Congress a report concerning the
results of--
``(A) the evaluations conducted under paragraph (1); and
``(B) an evaluation conducted by the Secretary to analyze
the effectiveness and efficacy of the activities conducted
with grants, collaborations, and consultations under this
section.
``(f) Authorization of Appropriations.--For the purpose of
carrying out subsection (a), there are authorized to be
appropriated $7,000,000 for fiscal year 2005, $16,000,000 for
fiscal year 2006, $25,000,000 for fiscal year 2007, and such
sums as may be necessary for each of fiscal years 2008 and
2009.
``SEC. 596B. MENTAL AND BEHAVIORAL HEALTH SERVICES ON CAMPUS.
``(a) Purpose.--It is the purpose of this section to
increase access to, and enhance the range of, services for
students with mental and behavioral health problems that can
lead to school failure, such as depression, substance abuse,
and suicide attempts, so as to ensure that college students
have the support necessary to successfully complete their
studies.
``(b) Program Authorized.--From funds appropriated under
subsection (j), the Secretary shall award competitive grants
to institutions of higher education to create or expand
mental and behavioral health services to students at such
institutions, to provide such services, and to develop best
practices for the delivery of such services. Such grants
shall, subject to the availability of such appropriations, be
for a period of 3 years.
``(c) Eligible Grant Recipients.--Any institution of higher
education that seeks to provide, or provides, mental and
behavioral health services to students is eligible to apply
for a grant under this section. Services may be provided at--
``(1) college counseling centers;
``(2) college and university psychological service centers;
``(3) mental health centers;
``(4) psychology training clinics; and
``(5) institution of higher education supported, evidence-
based, mental health and substance abuse screening programs.
``(d) Applications.--Each institution of higher education
seeking to obtain a grant under this section shall submit an
application to the Secretary. Each such application shall
include--
``(1) a description of identified mental and behavioral
health needs of students at the institution of higher
education;
``(2) a description of currently available Federal, State,
local, private, and institutional resources to address the
needs described in paragraph (1) at the institution of higher
education;
``(3) an outline of program objectives and anticipated
program outcomes, including an explanation of how the
treatment provider at the institution of higher education
will coordinate activities under this section with existing
programs and services;
``(4) the anticipated impact of funds provided under this
section in improving the mental and behavioral health of
students attending the institution of higher education;
``(5) outreach strategies, including ways in which the
treatment provider at the institution of higher education
proposes to reach students, promote access to services, and
address the range of needs of students;
``(6) a proposed plan for reaching those students most in
need of services;
``(7) a plan to evaluate program outcomes and assess the
services provided with funds under this section;
``(8) financial information concerning the applicant to
demonstrate compliance with subsection (h); and
[[Page S7867]]
``(9) such additional information as is required by the
Secretary.
``(e) Peer Review of Applications.--The Secretary, in
consultation with the Secretary of Education, shall provide
the applications submitted under this section to a peer
review panel for evaluation. With respect to each
application, the peer review panel shall recommend the
application for funding or for disapproval.
``(f) Use of Funds.--Funds provided by a grant under this
section may be used for 1 or more of the following
activities:
``(1) Prevention, screening, early intervention,
assessment, treatment, management, and education of mental
and behavioral health problems that can lead to school
failure, such as depression, substance abuse, and suicide
attempts by students enrolled at the institution of higher
education.
``(2) Education of families to increase awareness of
potential mental and behavioral health issues of students
enrolled at the institution of higher education.
``(3) Hiring staff trained to identify and treat mental and
behavioral health problems, including residents and interns
such as those in psychological doctoral and post doctoral
programs.
``(4) Evaluating and disseminating outcomes and best
practices of mental and behavioral health services.
``(g) Additional required elements.--Each institution of
higher education that receives a grant under this section
shall--
``(1) provide annual reports to the Secretary describing
the use of funds, the program's objectives, and how the
objectives were met, including a description of program
outcomes;
``(2) perform such additional evaluations as the Secretary
may require, which may include--
``(A) increases in range of services provided;
``(B) increases in the quality of services provided;
``(C) increases in access to services;
``(D) college continuation rates;
``(E) decreases in college dropout rates;
``(F) increases in college graduation rates; and
``(G) accepted and valid measurements and assessments of
improved mental health functionality; and
``(3) coordinate such institution's program under this
section with other related efforts on campus by entities
concerned with the general mental and behavioral health needs
of students.
``(h) Supplement not Supplant.--Grant funds provided under
this section shall be used to supplement, and not supplant,
Federal and non-Federal funds available for carrying out the
activities described in this section. Grantees shall provide
financial information to demonstrate compliance with this
subsection.
``(i) Requirement for Direct Services and Limitations.--
``(1) Direct services.--Not less than 75 percent of grant
funds received under this section shall be used to provide
direct services.
``(2) Administrative costs.--Not more than 5 percent of
grant funds received under this section shall be used for
administrative costs.
``(3) Prohibition on use for construction or renovation.--
Grant funds received under this section shall not be used for
construction or renovation of facilities or buildings.
``(j) Authorization of Appropriations.--There are
authorized to be appropriated for grants under this section,
$5,000,000 for fiscal year 2005, $7,000,000 for fiscal year
2006, $10,000,000 for fiscal year 2007, and such sums as may
be necessary for each fiscal years 2008 and 2009.
``SEC. 596C. DEFINITIONS.
``In this part:
``(1) Early intervention.--The term `early intervention'
means a strategy or approach that is intended to prevent an
outcome or to alter the course of an existing condition.
``(2) Educational institution; institution of higher
education; school.--The term--
``(A) `educational institution' means a school or
institution of higher education;
``(B) `institution of higher education' has the meaning
given such term in section 101 of the Higher Education Act of
1965; and
``(C) `school' means an elementary or secondary school (as
such terms are defined in section 901 of the Elementary and
Secondary Education Act of 1965).
``(3) Prevention.--The term `prevention' means a strategy
or approach that reduces the likelihood or risk of onset, or
delays the onset, of adverse health problems.
``(4) Youth.--The term `youth' means individuals who are
between 6 and 24 years of age.''.
____________________